This chapter will endeavor to further interpret the clinical material in terms of psychodynamic theory. Utilizing my psychiatric training background, I have employed psychoanalytic concepts as the main framework of reference in trying to understand these patients. Cultural idiosyncracies, however, modified these formulations to the extent that a rigid application of psychoanalytic theory became untenable. While constantly keeping the theory in mind, I had my eyes, ears, and other sensory receptors attuned to the culture. Also, while it was possible to carry out a coordinated and understandable system of translating Filipino behavior in terms of both pschodynamic theory and cultural assumptions, the task of deciding which of the two bore greater relevance to a given segment of behavior was, in some situations, extremely difficult to assess. The matter was often decided simply on an empirical basis in the clinical management of and psychotherapeutic experience with the patient.

Most of the conflicts of patients in the 20-50 years age group center around failure or success. This is probably due to the fact that this is the time in a man’s life when he makes his bid for success. Patients quickly launched into narrations of frustrations at work. Businessmen moaned about the vicissitudes brought on by ever changing political and economic conditions. Meeting bank deadlines, maneuvering loyalties of associates, chasing letters of credit, courting the politicians’ favor, etc., provided enough strain and stress for their emotional grind. Executives struggled with subordinates, often ambivalent about their authoritarian prerogatives towards the latter. Accommodating employees recommended by relatives or influential persons was a constant thorn in their side. Government employees reeled from the burdens of seniority in the service; some had conflicts involving unethical but generally accepted practices among other employees. A few had found themselves unfairly displaced by someone else with less qualifications but more impressive connections. Politicians in the sample were bitter over losing in elections or in failing to get the promised plum from their ward leaders. Skilled workers and professionals, such as doctors, lawyers, teachers were relatively more secure in their work and came with a discrete problem which did nor beat a direct relation to their job.

In all female patients diagnosed as cases of depressive reactions, separation was invariably one of the factors leading to the illness. The causes which combined to bring the woman to the brink of depression were several and varied. The last straw might be quite trivial or too obvious to be ignored—an unwanted pregnancy, a fight with her in-laws, a surgical operation, a sister ailing with a fatal disease, a religious retreat, a prolonged illness of a child, a neighborhood burglary, etc. The patient’s history revealed that she had been adjusting at an optimal level until something happened. This “something” was on the order of a separation from loved ones either in a literal or symbolic way. The emotional reactions immediately attendant to the separation might not be noticeable or obvious to the patient or her family. In retrospect, from this event could be traced the beginning inroads into her emotional equilibrium; and since that separation, things were never the same again. Following other psychological events, and depending on the load of stress they brought and the patient’s ability to utilize coping mechanisms, depression might be staved off for a shorter or longer period.

The great number of male adolescents in this study cannot be dismissed lightly. Of the 139 male patients, 41 were young students. This number is approximately half of the combined 21-40 years age group, a relatively greater percentage than the female counterpart. The adolescents ranged from 14.20 years of age, but there were five other boys who at age 23 or 24 continued to exhibit symptoms, behavior, and fantasy patterns which were strikingly adolescent.

Parental unhappiness and anxiety over his performance in school, the adolescent’s temper outbursts arid uncontrolled activities, or the appearance of somatic illness or markedly phobic behavior were reasons which brought him, and his parents, to the psychiatrist. The mother was nearly always the parent more concerned and upset; it was she who discussed the problem first with the doctor before the boy was seen. It was not unusual, however, to see her come with the adolescent in tow and the problem stated then and there. “He can’t sleep”; “He won’t leave his room”; “He can’t control himself”; or “He’s failing in Pilipino and Math” were the usual first statements.

A patient in this study regarded sexual intercourse as primarily an idiosyncratic habit of men in which the wife was expected to participate dutifully if not willingly. She felt that a good wife should indulge the husband in his sexual needs so as to keep his interest from wandering to other women. Although she denied that it was a source of pleasure to her, she was ever-watchful that her husband does not bring this prerogative, which she felt to be hers alone, elsewhere. She did say on further questioning that she derived some pleasure from it, but described this feeling more on the level of being wanted, feeling close, feeling loved. Hardly was there any wife who said she made the initial overture to have sexual intercourse. Talking with male patients, however, it seemed that men could perceive many varied hints from the wife to indicate a desire for sex on her part, e.g. picking an argument with him, general short-temperedness, sleeping with the children in another room, cooking his favorite food, waiting up for him, taking a bath after supper, etc.